No office rate
Choose 64864 for extracranial cranial nerve repair. Code 64865 applies to intracranial repair requiring craniotomy.
On this page
CMS RVU26D · Effective 2026-10-01
64864 Facial nerve repair Medicare reimbursement rates
Reports surgical suture repair of an extracranial facial nerve injury, such as a transection requiring operative reconnection of the nerve ends. Compare 64864 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 64864?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 64864 pays more and less
Nerve surgery
About 64864: Extracranial cranial nerve repair
Reports surgical suture repair of an extracranial facial nerve injury, such as a transection requiring operative reconnection of the nerve ends.
This service involves surgically reconnecting an injured extracranial cranial nerve, most often the facial nerve, by bringing the nerve ends together and repairing them. It may be performed by an otolaryngologist, plastic surgeon, or neurosurgeon in an operating room after facial trauma or an operative injury, including damage encountered during parotid-region surgery. The repair is distinct from reconstruction that bridges a nerve gap with a graft or redirects another nerve to restore facial function.
Report the code when the operative record supports repair of an extracranial cranial nerve and identifies the nerve and repair performed. The day-before preoperative visit and 90 days of related postoperative care are included in the major-surgery global period. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is not appropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 64864
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU13.07 · 58%
- Practice expense (office) RVU7.35 · 33%
- Malpractice RVU2.19 · 10%
180
Medicare services in 2024 · #4425 by national volume
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
64864 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
No office rate
64864 repairs the injured nerve itself; 64866 is used for a facial-to-hypoglossal nerve connection.
No office rate
64864 describes repair by reconnecting the injured nerve. Code 64885 is for head-and-neck nerve reconstruction using a graft under 4 cm.
No office rate
Use 64886 for head-and-neck nerve graft reconstruction when the graft is over 4 cm, rather than direct repair under 64864.
See how rates vary across the country
64864 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Compare 64864 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office Unavailable | Facility $692.76 |
| Alaska* | Office Unavailable | Facility $956.58 |
| Arizona | Office Unavailable | Facility $737.05 |
| Arkansas | Office Unavailable | Facility $685.10 |
| Atlanta | Office Unavailable | Facility $775.13 |
| Austin | Office Unavailable | Facility $761.97 |
| Bakersfield | Office Unavailable | Facility $758.46 |
| Baltimore/Surr. Cntys | Office Unavailable | Facility $797.44 |
| Beaumont | Office Unavailable | Facility $727.91 |
| Brazoria | Office Unavailable | Facility $740.38 |
| Chicago | Office Unavailable | Facility $854.20 |
| Chico | Office Unavailable | Facility $752.24 |
| Colorado | Office Unavailable | Facility $760.13 |
| Connecticut | Office Unavailable | Facility $798.19 |
| Dallas | Office Unavailable | Facility $747.75 |
| Dc + Md/Va Suburbs | Office Unavailable | Facility $830.73 |
| Delaware | Office Unavailable | Facility $747.04 |
| Detroit | Office Unavailable | Facility $796.78 |
| East St. Louis | Office Unavailable | Facility $809.73 |
| El Centro | Office Unavailable | Facility $752.61 |
| Fort Lauderdale | Office Unavailable | Facility $817.49 |
| Fort Worth | Office Unavailable | Facility $746.25 |
| Fresno | Office Unavailable | Facility $752.24 |
| Galveston | Office Unavailable | Facility $744.39 |
| Hanford-Corcoran | Office Unavailable | Facility $752.24 |
| Hawaii, Guam | Office Unavailable | Facility $758.03 |
| Houston | Office Unavailable | Facility $784.47 |
| Idaho | Office Unavailable | Facility $697.01 |
| Indiana | Office Unavailable | Facility $699.68 |
| Iowa | Office Unavailable | Facility $690.22 |
| Kansas | Office Unavailable | Facility $695.35 |
| Kentucky | Office Unavailable | Facility $721.73 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $793.44 |
| Madera | Office Unavailable | Facility $752.24 |
| Manhattan | Office Unavailable | Facility $865.77 |
| Merced | Office Unavailable | Facility $752.24 |
| Metropolitan Boston | Office Unavailable | Facility $812.67 |
| Metropolitan Kansas City | Office Unavailable | Facility $738.54 |
| Metropolitan Philadelphia | Office Unavailable | Facility $787.24 |
| Metropolitan St. Louis | Office Unavailable | Facility $743.56 |
| Miami | Office Unavailable | Facility $877.10 |
| Minnesota | Office Unavailable | Facility $710.82 |
| Mississippi | Office Unavailable | Facility $701.98 |
| Modesto | Office Unavailable | Facility $752.24 |
| Montana** | Office Unavailable | Facility $755.05 |
| Napa | Office Unavailable | Facility $824.78 |
| Nebraska | Office Unavailable | Facility $690.79 |
| Nevada** | Office Unavailable | Facility $743.22 |
| New Hampshire | Office Unavailable | Facility $756.12 |
| New Mexico | Office Unavailable | Facility $749.52 |
| New Orleans | Office Unavailable | Facility $750.66 |
| North Carolina | Office Unavailable | Facility $712.34 |
| North Dakota** | Office Unavailable | Facility $711.74 |
| Northern Nj | Office Unavailable | Facility $826.95 |
| Nyc Suburbs/Long Island | Office Unavailable | Facility $892.22 |
| Ohio | Office Unavailable | Facility $734.42 |
| Oklahoma | Office Unavailable | Facility $712.61 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $784.52 |
| Portland | Office Unavailable | Facility $770.70 |
| Poughkpsie/N Nyc Suburbs | Office Unavailable | Facility $813.52 |
| Puerto Rico | Office Unavailable | Facility $756.80 |
| Queens | Office Unavailable | Facility $860.15 |
| Redding | Office Unavailable | Facility $752.24 |
| Rest Of California | Office Unavailable | Facility $752.24 |
| Rest Of Florida | Office Unavailable | Facility $781.19 |
| Rest Of Georgia | Office Unavailable | Facility $742.73 |
| Rest Of Illinois | Office Unavailable | Facility $775.02 |
| Rest Of Louisiana | Office Unavailable | Facility $723.89 |
| Rest Of Maine | Office Unavailable | Facility $707.90 |
| Rest Of Maryland | Office Unavailable | Facility $756.51 |
| Rest Of Massachusetts | Office Unavailable | Facility $760.34 |
| Rest Of Michigan | Office Unavailable | Facility $743.27 |
| Rest Of Missouri | Office Unavailable | Facility $719.41 |
| Rest Of New Jersey | Office Unavailable | Facility $802.34 |
| Rest Of New York | Office Unavailable | Facility $721.19 |
| Rest Of Oregon | Office Unavailable | Facility $732.49 |
| Rest Of Pennsylvania | Office Unavailable | Facility $731.04 |
| Rest Of Texas | Office Unavailable | Facility $735.58 |
| Rest Of Washington | Office Unavailable | Facility $756.40 |
| Rhode Island | Office Unavailable | Facility $763.69 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $775.87 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $776.99 |
| Salinas | Office Unavailable | Facility $773.82 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $782.91 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $857.75 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $855.26 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $877.78 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $867.62 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $762.80 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $783.20 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $774.23 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $790.32 |
| Seattle (King Cnty) | Office Unavailable | Facility $819.36 |
| South Carolina | Office Unavailable | Facility $725.56 |
| South Dakota** | Office Unavailable | Facility $706.62 |
| Southern Maine | Office Unavailable | Facility $725.99 |
| Stockton | Office Unavailable | Facility $752.24 |
| Suburban Chicago | Office Unavailable | Facility $821.35 |
| Tennessee | Office Unavailable | Facility $698.99 |
| Utah | Office Unavailable | Facility $733.00 |
| Vallejo | Office Unavailable | Facility $821.19 |
| Vermont | Office Unavailable | Facility $716.60 |
| Virgin Islands | Office Unavailable | Facility $756.80 |
| Virginia | Office Unavailable | Facility $729.52 |
| Visalia | Office Unavailable | Facility $752.24 |
| West Virginia | Office Unavailable | Facility $754.56 |
| Wisconsin | Office Unavailable | Facility $694.27 |
| Wyoming** | Office Unavailable | Facility $736.18 |
| Yuba City | Office Unavailable | Facility $752.24 |
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64864 billing questions
How is this different from 64865?
64864 is for repair of an extracranial cranial nerve. Code 64865 describes intracranial cranial nerve repair requiring craniotomy.
When would a nerve graft code be more appropriate?
Use a head-and-neck nerve graft code when the operative reconstruction bridges a nerve defect with graft material rather than directly reconnecting the nerve ends. Codes 64885 and 64886 distinguish graft length.
Can modifier 50 be appended for repairs on both sides?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
What postoperative care is included?
The major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What documentation supports reporting 64864?
Document the injured extracranial nerve, the operative findings, and the repair performed. The record should distinguish direct nerve repair from graft reconstruction or nerve transfer.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
7,25964859,,Nerve surgery,A,,4.14,1.32,NA,1.32,,0.89,6.35,6.35,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,26064861,,Repair of arm nerves,A,,20.37,16.31,NA,16.31,,8.59,45.27,45.27,0,090,0.11,0.76,0.13,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,26164862,,Repair of low back nerves,A,,20.56,12.11,NA,12.11,,4.38,37.05,37.05,0,090,0.11,0.76,0.13,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,26264864,,Repair of facial nerve,A,,13.07,7.35,NA,7.35,,2.19,22.61,22.61,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,26364865,,Repair of facial nerve,A,,15.69,10.39,NA,10.39,,2.30,28.38,28.38,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,26464866,,Fusion of facial/other nerve,A,,16.41,14.29,NA,14.29,,3.04,33.74,33.74,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,26564868,,Fusion of facial/other nerve,A,,14.53,9.34,NA,9.34,,2.12,25.99,25.99,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00